While the national mental health parity law takes effect on January 1, 2010, it does not trump existing state laws that mandate that mental disorder diagnoses are treated and covered equally as their physical health brethren. If you are covered by health insurance, come January 1, your mental health treatment cannot be any more limited than your physical health coverage. California is one such state that has had such a mental health parity law on the books since 2000, so we have nine years of lessons from that state.
Recently, a study was released that examined how the law affected people who sought out mental health treatment. Shari Roan with the Los Angeles Times has the coverage. The study, conducted by Mathematica Policy Research and the Substance Abuse and Mental Health Services Administration, looked at data from 2000 to 2005 and found some things in line with expectations:
- “Costs associated with parity were in line with, or even below, the projections.”
This is not surprising, given that projections are usually based upon real-world scenarios of how mental health care is delivered and paid for.
- “Most health plans responded to the parity law by lifting limits on the annual number of days allowed for inpatient treatments and the number of visits allowed for outpatient treatment.”
Indeed, since it is mandated by the law, health insurance companies had little choice but to lift these limits.
- “Consumers also complained about being referred to lists of mental-health providers only to find out that providers on the list were not taking new patients.”
This is a common, continuing problem not only with mental health providers, but general providers under health insurance plans. In fact, it’s one of the most common complaints about health insurance in the U.S.
- “Some doctors reported that they chose a parity diagnosis for a patient in order to ensure insurance coverage although it wasn’t the most accurate diagnosis. Some doctors said they had little flexibility to change a client’s diagnosis if he or she improved because they believed the health plan would then stop providing coverage for continuing care or care for a lesser diagnosis.”
This is nothing new. Mental health treatment providers have been choosing “covered” diagnoses for patients rather than “not-covered” diagnoses for decades (ever since managed care came on the scene). While certainly far from an ideal situation, this is forseeable outcome of having a list of approved versus unapproved and non-reimbursable diagnoses. This will remain a problem with the new law as well.
However, the study also found some things that policy makers may have not expected or planned for:
- “Concerns arose over the use of “medical necessity” clauses to authorize treatments and control costs. Medical necessity is typically defined as the need to supply a service for a condition that could endanger life or cause significant illness, suffering or disability and for which there is no adequate, less costly alternative available.”
This is going to be the newest loophole used by insurance companies to refuse to pay for mental health services provided. You’d think that only your therapist or doctor could determine “medical necessity,” but leave it to insurance companies to make that determination from afar.
- “Health insurance providers felt the list of diagnoses covered under the parity law was arbitrary in excluding certain diagnoses.”
I believe the new parity law covers a wider range of diagnoses, so this should be as serious a concern.
- “Nearly half of Californians polled in focus groups were unaware of the parity law.”
This is an unexpected and unfortunate problem, in that consumers don’t necessarily know what their rights are when it comes to getting treatment that is reimbursable from their health insurer. But it is a problem that is hopefully easily solved through more outreach and education.
Mental health parity is sometimes viewed as a panacea, in that it will suddenly solve a lot of problems regarding the treatment of mental health concerns. That is not likely the case, but what it will do is make it easier for treatment providers like psychologists to see patients for as long as they need to be seen. Assuming that the “medical necessity” isn’t turned into another barrier for continuing mental health treatment, as the California study found.
Read the full article: Mental-health parity laws require oversight
5 comments
There are also ways for employers to get around having to have parity in their health insurance and possibly have slightly higher premiums. My university where I am a graduate student only provides individual policies to purchase (through one specific company- so it might as well be a group policy). But because it is not a group policy and we are required to have health insurance we get very little mental health coverage ($300/psychotropic medications $500/therapy, per year). It doesn’t cover anything really especially since none of the providers in the area are on their panel since there is such low reimbursement. UGH!
I was caught in a loophole when I had to leave my job of 9 years for mental health and physical health issues. I had worked in and had my insurance through the State of NH “Anthem”. NH state law says that ‘a biologically based mental health diagnosis can not be a limited number of visits or dollar capped’. This allowed me to be in a controlled environment as needed, when the local hospital felt they could not address my needs, a transfer to a highly renowned specialty, private hospital in Mass. was arranged- After a total of 16 weeks as an inpatient, my insurance ended (my employer had been paying the full premium for the entire time).I never saw a bill for any of it! I was able to get insurance through my husband’s employer- “Anthem” again, but his employer was based in Ohio, so they said they could put limits on my treatment- 10 in-patient days per benefit year and 20 out-patient visits(which include medication checks AND therapy). I used my benefit for the year within 2 months! I am hoping that these new federal laws will change that. I have had to be on the state’s ‘medicaid’ since the change, because my bills are so large.
California has had mental health parity for a while now so I’m not sure why they chose to survey Californians about the “new” mental health parity law.
I personally think a big flaw in the assumptions with mental health parity is that people assume that more treatment = a better outcome, which, as we saw in the Harrow and Jobe study published in 2007 in the Journal of Mental and Nervous Disease, is just not necessarily the case.
I have been paying out of pocket expenses for psychiatric care of $1100.00/year. It is unfair that participating providers only spend 10 minutes with a bipolar patient. To manage our medications properly, it takes almost an hour.
In addition, general practitioners do not want to deal with psychiatric medications even though they can raise your blood sugar, cholesteral, pulse rate, etc. They want to treat the symptoms, not the cause. There should be a way to make the GP work with the patient’s psychiatrist in order to get reimbursement for treatments necessary due to medication symptoms. Maybe then they would pay attention and become better informed.
I personally feel my son has been screwed with this new law as many other children will be. My prior coverage through insurance for mental health coverage did not need to meet a deductible and got 20 visits a year at 100% coverage. Now with this new law I have a $750 deductible has to be met first, then 30%of each visit. Sure he can have as many visits he wants, but only if my orange tree starts growing money. What good does as many visits as I want do, if I can not afford them. At $120 bucks a visit, even if I only send him once a month, would take me 6 months to even get to the 30% I am a single mom and I for one do not have this kind of money. So who loses?? my son does. Cause if I paid for that then that would take food away from our table.
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